Please complete the following questionnaire using a computer (not a mobile device such as a mobile phone or tablet). Thank you.

I am attending as a...

The Love & Ecstasy Training consists of three Cycles. Which have you completed so far?

LET Cycle 1

LET Cycle 2

LET Cycle 3

1. Please describe your experience with Tantra, listing Tantra workshop/s you have taken including names of facilitators.

2. What do you expect from this training, and why are you attending it?

3. Are there any difficulties in your sex life right now? Please explain.

4. Do you have any fears regarding this training? If yes, what are they?

5. Have you taken or are you currently taking any medication for mental and/or emotional conditions? If yes, please explain.

6. Do you have any kind of physical or emotional conditions we should know about? If yes, please explain.

7. Have you ever attempted to commit suicide? If yes, please explain.

If you answered “yes” to the previous four questions, it is crucial that we know about the circumstances of your past issues and the extent to which they have been treated. We will contact you to discuss this with you further.

8. Please let us know anything else you think is pertinent about you that we should know about.

9. Indicate your meal preference; the caterers will do their best to accommodate your needs.

10. Have you assisted at any of our Ecstatic Living events in the past, or would you like to know more about the Ecstatic Living Assisting Program?

Yes

No

By clicking “Yes” below and typing your full name in the “E-signature”, I understand that this training is for my personal growth and is not a form of therapy, nor can it replace therapy should such be needed. I declare that my personal information in this questionnaire is true and correct.

Please expect to receive an email from us confirming that we have successfully received your questionnaire. If you do not receive this email with 24 hours, or if you have any questions, please call our office at 844-987-3456 (toll-free) or 707-987-3456 (internationally). Thank you.